Krüger Stefan, Graf Jürgen, Merx Marc W, Stickel Tina, Kunz Dagmar, Koch Karl Christian, Hanrath Peter, Janssens Uwe
Medical Clinic I, University Hospital, University of Technology, Aachen, Germany.
Eur J Intern Med. 2006 Mar;17(2):96-101. doi: 10.1016/j.ejim.2005.11.001.
A peak VO2 above 14 ml/min/kg at cardiopulmonary exercise testing and brain natriuretic peptide (BNP) levels is used to estimate survival in patients with chronic heart failure (CHF). Limited data, however, exist comparing the prognostic value of both markers simultaneously in patients with mild to moderate CHF.
We prospectively studied 85 consecutive patients (59+/-13 years, 63 men) with CHF (mean LVEF 26+/-6%). All patients underwent cardiopulmonary exercise testing with determination of peak VO2 and measurement of plasma BNP at rest. The incidence of cardiac decompensation and cardiac death was recorded in the follow-up.
During a mean follow-up of 427+/-150 days, four deaths and ten cardiac decompensations occurred. Kaplan-Meier estimates of freedom from clinical events differed significantly for patients above and below the median BNP of 292 pg/ml and also for patients above and below a peak VO2 of 14 ml/min/kg (p<0.05 each). BNP and peak VO2 (area under the ROC 0.75 vs. 0.72) showed a comparable discrimination of CHF patients with adverse cardiac events. The prognostic information of BNP was at least as powerful as that derived from peak VO2. A BNP above 324 pg/ml was associated with a risk ratio of 8.8 for adverse cardiac events.
In patients with mild to moderate CHF, BNP measurements appear to be an alternative to peak VO2 determined by cardiopulmonary exercise testing for the assessment of prognosis in CHF. BNP may facilitate the ambulatory management of patients with mild to moderate CHF since it is less expensive, less time-consuming, and free of procedural risk compared to exercise testing.
在心肺运动试验中，峰值摄氧量（VO₂）高于14 ml/（min·kg）以及脑钠肽（BNP）水平被用于评估慢性心力衰竭（CHF）患者的生存率。然而，关于在轻度至中度CHF患者中同时比较这两种标志物预后价值的资料有限。
我们对85例连续的CHF患者（年龄59±13岁，男性63例）进行了前瞻性研究（平均左心室射血分数[LVEF] 26±6%）。所有患者均接受了心肺运动试验以测定峰值VO₂，并在静息状态下测量血浆BNP。随访期间记录心脏失代偿和心源性死亡的发生率。
在平均427±150天的随访期间，发生了4例死亡和10次心脏失代偿。对于BNP中位数292 pg/ml以上和以下的患者，以及峰值VO₂ 14 ml/（min·kg）以上和以下的患者，Kaplan-Meier估计的无临床事件生存率有显著差异（均p<0.05）。BNP和峰值VO₂（ROC曲线下面积分别为0.75和0.72）对发生不良心脏事件的CHF患者具有相似的辨别能力。BNP的预后信息至少与峰值VO₂相当。BNP高于324 pg/ml与不良心脏事件的风险比为8.8相关。
在轻度至中度CHF患者中，测量BNP似乎可替代通过心肺运动试验测定的峰值VO₂来评估CHF的预后。与运动试验相比，BNP可能有助于轻度至中度CHF患者的门诊管理，因为它成本更低、耗时更少且无操作风险。
